Vertragsarzt Zulassung

With a license as a panel doctor or psychotherapist, you may bill services for legally insured patients via the Association of Statutory Health Insurance Physicians with the statutory health insurance funds.

Doctors and psychotherapists who treat persons with statutory health insurance and want to settle accounts through the Association of Statutory Health Insurance Physicians must have a contract medical license. You must apply for this at the responsible admission committee for doctors.

The committees grant the approvals in compliance with the legally prescribed admission restrictions within the framework of demand planning.

The admission obliges you to exercise the contract medical activity. You can apply for authorisation to the extent of a full, three-quarters or half-service order.

Note: In areas where there is an oversupply according to demand planning, admission restrictions are imposed. There you have to expect admission restrictions.

• Extract from the medical register with the following data:
  • Date of approbation
  • Date of entry in the medical register
  • Date of recognition of the right to use specialist, specialisation or additional titles
• Curriculum vitae
• Certificate of good conduct of document type O or extended certificate of good conduct according to § 30a Federal Central Register Act
• Declaration of service or employment relationships existing at the time of application (indicating the earliest possible end of the employment relationship)
• Statement as to whether you
  • are addicted to drugs or alcohol, or
  • have been addicted to drugs or alcohol within the last 5 years, or
  • have undergone a withdrawal cure for drug or alcohol addiction within the last 5 years and
  • that statutory impediments do not preclude the exercise of the medical profession.

• The competent authority may request further documents, e.g.
  • Certificates from the Associations of Statutory Health Insurance Physicians in whose area you were previously established or admitted to the health insurance practice
    (indicating the place and duration of establishment or authorisation and the reason for any termination)

You must present the documents in the original or as officially certified copies.
 

Note: If you are unable to provide certificates of your medical activities, you must substantiate the facts to be proven in a different way. Check with the competent authority.

Prerequisites for admission are:

• You are entered in the medical register of the Association of Statutory Health Insurance Physicians as a doctor or psychotherapist.
• Despite an employment relationship or other non-voluntary activities, you are available to the insured persons in the amount of time associated with your admission to care for those with statutory health insurance.
• They do not pursue any medical activity which is incompatible by its nature with that of a panel doctor.
• You are not only temporarily unable to properly exercise the activity of a panel physician for health or other serious reasons in your person.

Note: In the event of impediments within the meaning of the second or third indent, you can obtain admission under certain conditions.
 

You must remedy the reason for non-suitability no later than 3 months after the authorisation has become final. Activities in approved hospitals, preventive care or rehabilitation facilities do not stand in the way of a contract medical activity, provided that you are personally available to the insured persons to the extent of your approved care mandate.

• For the application for admission: 100,00 Euro
• Definitive fee (after admission has become final): 400.00 Euro

You must apply for admission in writing to the office of the Admissions Committee for Doctors responsible for your place of establishment (panel doctor's seat).

The application must contain the following information:

• for which panel doctor seat the authorisation is applied for
• under which medical title the authorisation is applied for

The Admissions Committee decides on the application by means of an order after oral proceedings. The decision states the date by which you must commence your activity as a panel physician at the registered office.

The decision will be served on you together with information on the right of appeal. All parties to the proceedings (e.g. Association of Statutory Health Insurance Physicians, regional associations of health insurance funds) may object to the decision.

They must commence the activity of panel physician by the date specified in the decision.

Note: If there are important reasons, the Admissions Committee may, at the request of the doctor, subsequently set a later date for the commencement of the practice.

Exception: If you obtain a licence for a panel doctor's seat in a planning area that is affected by admission restrictions, you must commence the activity of panel physician within three months of notification of the decision, otherwise the licence expires.

The approval of statutory health insurance physicians entitles doctors and psychotherapists to bill services via the Association of Statutory Health Insurance Physicians (KV) at the expense of the statutory health insurance companies.